QUALITY STRATEGY

Transcription

1 QUALITY STRATEGY

2 HOW YOU CAN HELP US SHAPE OUR PRIORITIES Engagement Western Sussex Hospitals has a proud history of involving patients, the public, its foundation Trust members and staff in the development of the services we provide. This includes the planning, designing, delivering and improvement of services to ensure they are of high quality and responsive to the needs of the diverse community that we serve. This has been achieved through our well established stakeholder Forum, a range of patient participation groups, our Patient Advice and Liaison team as well as our patient feedback programme. We want to build on this success and ensure that through our Quality Strategy , we continually improve the quality of the service we provide, in line with the standards laid out for us both nationally and, importantly by our patients. Therefore we have developed the following engagement goals: We will provide the opportunities, information and support people need to contribute to the conversation regarding the Trust s clinical priorities. This will include patients, public, members and staff We will promote equality by ensuring we engage with people who represent the diverse communities we work within; and in particular making sure we are engaging effectively with those facing health inequalities due to their background Principles of engagement In order to achieve these goals we will adhere to the following engagement principles: Ensure people in all parts of the organisation have a shared understanding of what is meant by involvement and its purpose Ensure there are adequate resources available to support the engagement programme Focus on improving services, rather than problems that need to be solved Be clear about why we are asking patients and the local community to be involved, and what is possible as well as what is not. Duty to engage It is also important to note that we have a duty to engage under Section 242 of the NHS Act 2006 to engage our stakeholders in the planning, development and operation of our services. This includes formal consultation when necessary and ensuring that stakeholders are informed whether or not the consultation is due to a substantial variation in service. Engagement will be continuous, accessible and transparent

3 HOW YOU CAN HELP US SHAPE OUR PRIORITIES How to get involved The Trust is keen to involve as broad an audience as possible in the development of the strategy including the following key groups: Patients Patients families and visitors Patient groups Staff Members Wider public (potential patients/ visitors) Healthwatch and other public health groups League of Friends charities and other supporters groups Local partners and interested parties, including local authorities, MPs and community associations Stakeholders are invited to comment on the Trust s draft strategy document. The document includes information about how the Trust is currently performing along with four goals for the next three years, stories about how care has improved in recent years and plans to go on improving as well as a survey for participants to give their feedback and highlight their concerns and priorities. Social media Facebook/Twitter. Traditional media Local press, radio Postcard/ leaflet distribution Governor engagement Staff briefings Staff newsletter/intranet/ Posters in key public places Feet on the ground promotions Public meetings Stakeholder briefing Third party organisations internal communications The engagement exercise will run throughout February with responses collated using online software. The results will then be fed back to the Quality Strategy board and to inform the next stage of the Quality Strategy s development. The results will also be shared with stakeholder online as well as at the Trust s Stakeholder forum. The document will be available in hard copy and on the Trust s website. The Trust is keen to make the consultation a genuine opportunity for stakeholder engagement and input in to the strategy. The primary way in which people can give their views is to complete an online survey and this will be promoted in a number of ways to encourage as many people as possible to participate. These include:

4 What are we trying to achieve? As an organisation we aim to provide the best care every time. Western Sussex Hospitals NHS Foundation Trust (WSHFT) is developing a new Quality Strategy that sets out a programme of work to support continuous improvement in the quality of care we provide. We aim to provide the best care every time. We will focus our attention on programmes of work that will ensure that we continuously improve the safety and reliability of the care that we give to patients, but also improve their experience of that care. Key goals Reducing mortality and improving outcomes Safe care Reliable care Improved patient and staff experience We will build on the strong foundations we have in place in delivering high quality care. The delivery of our ambition to provide the best care every time will be underpinned by significant investment in our Patient First programme. Patient First The Trust has recently launched its Patient First programme, a long term programme which has as its aim a transformation in the way we deliver services to patients. Patient First is based on standardisation, system redesign and the improvement of patient pathways to eliminate error and waste and improve quality. The philosophy behind the programme is centred on: The patient being at the heart of every element of change The need for cultural change across the organisation Continuous improvement of our services through incremental change Constant re-testing of the patient pathway Redesign processes led by frontline staff Equal voices for all The structure and approach of the programme is represented by the triangle below.

5 Reducing mortality and improving outcomes GOAL: To be in the 20% of NHS organisations with lowest risk adjusted mortality We aim to reduce avoidable mortality and improve the clinical outcomes of patients receiving care at our hospitals. We will benchmark ourselves against other NHS organisations with a goal to be one of the NHS organisations with the lowest risk adjusted mortality rates. Why is this important? About half of all deaths in the UK take place in hospital. The overwhelming majority of these deaths are unavoidable. The person dying has received the best possible treatment to try to save his or her life, or it has been agreed that further attempts at cure would be futile and the person receives palliative treatment. We know, however, that in all healthcare systems things can and do go wrong. Healthcare is very complex and sometimes things that could be done for a patient are omitted or else errors are made which cause patients harm. Sometimes this means that patients die who might not have, had we done things differently. This is what we mean by avoidable mortality. More often, if things go wrong with care, patients fail to achieve the optimal level of recovery or improvement. By concentrating on this area we will end up with safer hospitals, save lives, and ensure the best possible clinical outcomes for patients. How do we monitor it? Hospital mortality refers to the number of patients who die while in hospital. The simplest way of measuring this is looking at the crude rate, that is the number of deaths in hospital as a percentage of the total number of patients discharged. Given the very low mortality for elective care (care that is scheduled in advance because it does not involve a medical emergency), this is usually done for non-elective patients only. There are two main tools available to the NHS to risk adjust mortality in this way: 1. The Hospital Standardised Mortality Ratio (HSMR) produced by Dr Foster Intelligence and 2. The Summary Hospital Mortality Indicator (SHMI) produced by the Health and Social Care Information Centre. These two tools both work in similar ways but the HSMR includes only the 56 diagnosis groups with the highest mortality, whereas the SHMI includes all diagnosis groups. The SHMI also includes deaths occurring in the 30 days following hospital discharge whereas the HSMR includes only in hospital deaths. The SHMI calculation also does not include the final stage of multiplying by 100 (a Trust with exactly as many deaths as predicted by each of the respective models would have an HSMR of 100, but a SHMI of 1.00). At WSHFT both these tools are used to measure mortality, however a greater focus is placed on the HSMR as this is available monthly (approximately three to four months after discharge) whereas the SHMI is only produced quarterly (approximately six to nine months after discharge). The crude non-elective mortality rate is also used as a more immediate indicator of progress or to identify areas of concern and to sense check that improvements are real and not the result of changes in coding or recording. Where are we now? Over the last few years crude non-elective mortality at WSHFT has fallen year on year from 3.60% in 2010/11 to 3.22% in 2013/14. Although relatively modest in terms of percentage this relates to almost 450 fewer deaths in 2013/14 than 2010/11. Crude Non-elective mortality 3.32% 3.30% 3.28% 3.26% 3.24% 3.22% 3.20% 3.18% 3.16% 11/12 12/13 13/ Dr Foster HSMR 11/12 12/13 13/ SHMI 11/12 12/13 13/14 However, in order to compare mortality rates between different NHS Trusts it is necessary to consider the mix of patients treated. For example a Trust with a very elderly, complex patient group might have a higher crude rate than one that had younger or less acutely ill patients. To adjust for this it is necessary to standardise the mortality rate for Trusts, thereby taking into account the patient mix. This is usually done by calculating an expected mortality rate based on the age, diagnosis and procedures carried out on the actual patients treated by each Trust. A mortality ratio is then calculated by dividing the actual number of deaths at a Trust by the expected number and multiplying by 100. A rate greater than 100 suggests a higher than average standardised mortality rate and less than 100 a better than average rate.

6 Reducing mortality and improving outcomes (continued) Over the same period the Trust s HSMR has moved from 98th in the country (of 141 non-specialist acute Trusts, i.e. 70th centile) to 64th (the 45th centile). A comparable level of improvement can also be seen in the Trust s SHMI score. 110 Dr Foster HSMR 2013/14 (following rebasing) th centile WSHFT Over the last few years we have focussed on reducing mortality particularly within the following disease groups: Pneumonia Chronic Obstructive Pulmonary Disease (COPD) Acute Kidney Injury Chronic Heart Failure 25% 20% 15% 10% Crude mortality in key conditions Despite an increasing complex and elderly case mix overall the Trust has showed a continued improvement in crude nonelective mortality. Over the course of the new Quality Strategy we propose to continue to focus on these areas (in particular on acute kidney injury, where we have not yet seen the level of reduction that we would like). In addition to this we will focus on reducing mortality in the following disease groups. Fluid and electrolyte disorders Hip fracture Genito-urinary bleeding We have introduced care bundle systems of care for patients with these conditions. Care bundles are small sets of evidencebased interventions which, when used together consistently by a single healthcare team, have been shown to significantly improve patient outcomes. We have also continued to use Patientrack software, an advanced observation and assessment system that gives our nurses and doctors early warning if a sick patient s condition is deteriorating, and thereby helps early and effective intervention to get things back on course. Patientrack increases patient safety and we expect it to help in reducing avoidable mortality. 5% 0% Pneumonia COPD Acute Kidney Injury 2011/ / /2014 Heart Failure Key Quality Improvement Priorities for We will deliver further continuous improvement in mortality rates across the organisation through a number of focused quality improvement programmes including: Implementation of care bundles to improve the recognition and care of physiologically deteriorating patients including sepsis, acute kidney injury and preventing cardiac arrest. Implementation of the Better Births programme focusing on normalising births and reducing stillbirths. Further development of a programme of structured review of every death occurring in the hospital to ensure learning.

7 Safe care GOAL: 100% of patients receiving safe, harm-free care as measured by the following six harms Pressure ulcers Catheter associated urinary tract infection Venous thromboembolism Harm from falls Hospital acquired infection Medication errors WSHFT is committed to providing safe, high quality services. We aim to provide safe, harm -free care for all patients, while we recognise that this is a challenging goal to achieve this, are we committed to reviewing all harms to ensure that we learn and continuously improve care. What is harm? Hospital acquired infections, pressure sores and other complications are examples of harm which are sadly commonplace across hospitals in the UK. Despite the extraordinary hard work of healthcare professionals patients are harmed in hospitals everyday. Most harm experienced by patients in minor or very minor but in some cases it can be life-changing for the patient and his family or can even tragically result in death. Harm is defined in many ways but a common belief in healthcare terms is that harm is unintended physical or emotional injury resulting from, or contributed to by clinical care (including the absence of indicated treatment or best practice) that requires additional monitoring, treatment or extended stay in hospital. Simply put, harm is suboptimal care which reaches the patient either because of something that should not have happened or as a result of something that should have happened but did not. such as deep vein thrombosis or pulmonary embolisms and urinary tract infections (UTI) for patients with catheters. This tool the NHS Patient Safety Thermometer is used nationally. It distinguishes between harms that have occurred prior to admission such as falls in care homes and those that have occurred since admission, known as new harms Health Care Acquired Infections such as MRSA and C. difficile are not currently included on the NHS Safety Thermometer but are nonetheless closely monitored. Errors in prescription and administration of drugs, although a significant cause of serious incidents nationally, is also not currently included in the NHS Patient Safety Thermometer. However the Trust plans to launch a Medication Safety Thermometer to support the data captured by the main Safety Thermometer. Where we are now? NHS Safety Thermometer Score for WSHFT No new harms Harmfree care Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2013 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Each month between 4% and 6% of patients suffer a harm event (a fall, pressure ulcer, VTE event or UTI with catheter). Of these, 2% occur after admission to WSHFT. Of the four types of harm currently measured by the patient safety thermometer, all four occurred at WSHFT during 2013/14. Future work streams will continue to focus all four of these areas as well as other aspects of ward safety. Breakdown of in-hospital patient harm (2013/14 Safety Thermometer) Measuring harm The Trust has an electronic reporting system for recording incidents and identifying patterns to help ensure that lessons are learned from both individual incidents and general themes. The Trust uses this system to report to the Trust Board the levels of incidents, medication errors, falls and pressure ulcers. In addition to this, one day every month there is a Trust-wide audit of every patient currently on an inpatient ward to identify whether they have suffered one or more of four potential harms: pressure ulcers, falls, venous thromboembolism events (VTE)

8 Safe care (continued) We have made significant progress in relation to infection control in recent years. Numbers of MRSA infections are now down to minimal levels, with four cases reported in 2013/14, but only one of which was considered avoidable. Similarly the level of C. difficile infections has also fallen from well over 100 per year prior to 2011/12 to 57 in 2013/ Cases of Hospital Attributable C difficile per year 11/12 12/13 13/14 We have made significant progress in reducing hospital acquired pressure ulcers over recent years. The following data is taken from our ongoing monitoring of all pressure ulcers. Key Quality Improvement Priorities for We will deliver further continuous improvement in the safety of care provided across the organisation through a number of focused quality improvement programmes aimed at: Reducing the incidence of hospital acquired infection Reducing the number of within hospitals falls Implementation of a Medicines Optimisation Strategy, including the introduction of electronic prescribing Further development the safety culture of the organisation The Trust is committed to maintaining a multi-faceted approach measuring improvements across a broad spectrum of indicators and will continue to work with partner organisations to drive down the overall percentage of patients suffering harm in all healthcare settings. Our priority is to ensure that no patients suffer harm while under our care and we have set an ambitious initial target of having 99% of patients suffering no new harms after admission to hospital Total hospital acquired pressure ulcers (grade 2+) /12 12/13 13/14 To supplement this the Trust will continue to closely monitor its performance in relation to healthcare acquired infections and, once established on the wards, use the Medication Safety Thermometer and the forthcoming electronic prescribing system to drive improvements in the safety of prescription and administration of medicines.

9 Reliable care GOAL: Achieve 95% reliability in the following: Stroke or high risk TIA care bundle Sepsis care bundle Acute Kidney Injury care bundle Achieve 100% reliability in the recording of patient observations (at frequency determined for specific patients), and appropriate escalation to promote early recognition of deteriorating patients Studies have shown that there is inconsistency in the delivery of high quality care and that patients often only receive a fraction of the care that is recommended. Reliability science can help health care providers redesign systems to make sure that more patients receive all the elements of care they need. Traditionally healthcare has monitored care given to patients by looking at individual aspects of that care. An example of this might be the number of patients who have had a stroke who are given aspirin within 24 hours of the event. Often hospitals would report their performance against these aspects of care individually. We know however, that best practice tells us there are a series of interventions that should be given within 24 hours of a stroke, and unless the patient receives all of them then their chance of the best possible outcome is reduced. These series of interventions are known as bundles. The Institute for Healthcare Improvement developed the concept of bundles to help health care providers to reliably deliver the best possible care for patients undergoing particular treatments with inherent improvements in outcome if the bundle is delivered reliably. Over the next three years we will use the principles of care bundles to improve care in the following areas: Stroke or high risk TIA, Sepsis, Acute Kidney Injury. Where we are now? As highlighted previously, over the last few years the Trust has introduced care bundle systems of care for patients with a number of conditions including: pneumonia, chronic obstructive pulmonary disease, acute kidney injury and chronic heart failure. This in addition to the deployment of Patientrack (the electronic observation and assessment system) improve patient safety and help to reduce avoidable mortality. The Trust has also implemented an Enhanced Recovery Programme supporting improvement in care pathways for patients having planned surgery including colorectal, hip and knee replacement, and gynaecological surgery. Over the last year we have also led significant developments in the pathways for patients with hip fracture and patients with dementia. Improvements in ortho-geriatric pathway An important area of focus over the last year has been the pathway for patients admitted with hip fracture. One of the key elements of the ortho-geriatric pathway is ensuring timely surgery for patients admitted with hip fracture. Performance is monitored very closely with updates on the proportion of appropriate patients operated on within this timeframe reported to the Chief Executive on a daily basis and to the Trust Board every month. Focus on this pathway has resulted in significant improvements in the timeliness of treatment for patients with hip fracture Proportion of patirnts with hip fracture operated on within 36 hours Apr 10 Jun 10 Aug 10 Oct 10 Dec 10 Feb 11 Apr 11 Jun 11 Aug 11 Oct 11 Dec 11 Feb 12 Apr 12 Jun 12 Aug 12 Oct 12 Dec 12 Feb 13 Apr 13 Jun 13 Aug 13 Oct 13 Dec 13 Feb 14 Apr 14 Jun 14 Aug 14 Oct 14 % op < 36hrs - all patients % op < 36hrs - medically fit Improvements in reliability of dementia screening As part of the national dementia Commissioning for Quality and Innovation (CQUIN) Programme we undertake a dementia screen for patients aged over 75 admitted within the first 72 hours of an emergency admission. To ensure the reliability of this process we record this assessment in real time using the Patientrack patient monitoring system. The software ensures quick and accurate recording of the assessment. Where patients are identified as suffering from memory problems, the screening assessment prompts the clinician to undertake further investigations and, in cases of suspected dementia, an to the patient s GP is automatically generated to ensure patients are referred to the appropriate service. For each quarter to date in 2014/15 we achieved better than the national 90% target for all three elements of this measure (the initial assessment, the further investigations and the onward referral). Since the launch of the system over 8000 assessments have been carried out and over 500 s sent to GPs identifying patients who would benefit from follow-up.

10 Seven Day Services Key Quality Improvement Priorities for GOAL: All new patients have a consultant review within 14 hours of hospital admission. The same service seven days a week If you need hospital care, you don t want it to be limited at weekends. That s why Western Sussex Hospitals are working towards providing Seven Day Service in line with national NHS targets. This includes improving access to doctors, diagnostics and emergency general surgeries every day. Ensuring consistency of care for all inpatients, regardless of when they are admitted to hospital, is a national priority. A report into seven day working, led by Sir Bruce Keogh, made a number of recommendations to improve safety, clinical outcomes and experience for inpatients, particularly at the weekends. These included ten clinical standards for inpatient care across the week, from admission to discharge and community support. Here at WSHFT, a group of doctors, nurses, therapists and managers has been examining how care can be made more consistent throughout the week. The group has begun to engage widely throughout the Trust, with partners and with patients, in order to understand some of the current challenges and gather ideas for improvement. We will deliver further continuous improvement in the reliability of care provided across the organisation through a number of focused quality improvement programmes including: Implementation of Stroke or high risk TIA care bundle Implementation of Sepsis care bundle Implementation of Acute Kidney Injury care bundle Improvement in referral and discharge information Implementation of seven day services programme Implementation of care pathway for frail elderly patients including building on dementia care pathway Cancer services - In addition we are working with two of our closest cancer centres to redesign cancer pathways for the benefit of all our patients and to ensure both quality and consistency across the organisation in the delivery of cancer care. As well as pathway redesign there will be improvements in acute Oncology, a marked increase in the local availability of chemotherapy for patients and the installation of two new linear accelerators and treatment planning CT scanner in the Trust. There are already some excellent examples of seven day or extended working within the Trust which improve the consistency of care for the most urgent patients. However, concerns have been highlighted in some areas such as the availability of senior decision-making, diagnostics and treatment intervention at the weekend. Plans are currently being developed to enable the Trust to work towards full achievement of the Keogh standards for inpatients over the next two years, working with community and primary care services and supported by Coastal West Sussex Clinical Commissioning Group.

11 Improved patient and staff experience GOAL: Achieve top 20% for patient and staff experience surveys Patient experience Improving the patient experience is at the heart of the Trust s vision and values, and is a central aspect of our Patient First programme. The Trust has invested heavily in staff training to improve the experience of patients through its customer care programme. This has resulted in the following: Induction and recruitment have been radically redesigned to ensure all staff are fully focused on delivering great care, this extends to the Induction Day and implementation of Welcome Day Successful pilot for delivery of Western Sussex Way training programme, aimed at groups of staff to improve customer care Over 50 staff have become ambassadors, to act as exemplars of best practice and guides to others. The National Friends and Family Test The Friends and Family Test (FFT) is a national tool that supports the people who use our services to have the opportunity to provide feedback on their experience, providing a way to highlight both good and poor patient experience. It asks people if they would recommend the services they have used and offers a range of responses. The Trust has collected this data across Accident and Emergency (A/E) and inpatient wards since April 2013, across maternity services since October 2013 and has recently launched the survey in day surgery and outpatient areas. Immediate feedback is provided to wards and departments on a continuous basis to ensure staff can address problems or get positive feedback as quickly as possible. Results are presented by a percentage recommending score (calculated as the % indicating that were either highly likely or likely to recommend the service, which is then divided by the total respondents including those who respond don t know ). Whilst we are above average in the percentage of patients recommending our A/E departments as a place to receive treatment, we aspire to be in the top 20% of acute Trusts and then to maintain this position. Percentage who would recommend AandE (2013/14) WSHFT-91% 80th centile-93%

12 Improved patient and staff experience (continued) For 2013/14 our inpatient wards were below average compared to other NHS services for the Friends and Family Test. We recognise that we have some way to go to be where we want to be so have set an initial goal to achieve a top 40% position with a vision of achieving the top 20% in the longer term. Percentage who would recommend AandE (2013/14) WSHFT-92% 80th centile-96% In order to achieve this improvement there a number of work streams in place focusing on the key themes that give poor experience. These themes have been identified from a number of sources: the national adult inpatient survey, feedback using our real-time survey system and local peer reviews. The key themes on which we will focus are: Night time care- reducing noise and night and ward moves that take place at night. Mealtime support Information and communication with particular focus on the involvement of relatives/carers and discharge planning

13 Staff experience The national NHS Staff Survey assesses the quality of staff experience through a number of questions, linked to the NHS Constitution. Possible scores range from 1 to 5, with 1 indicating that staff are poorly engaged (with their work, their team and their Trust) and 5 indicating that staff are highly engaged. Over the next 3 years, we will seek to improve our overall engagement score annually so that we are in the top 20% of acute Trusts. Engagement scores for each Division will inform where our attention needs to be focused and inform our improvement plans. 100 Staff who would be happy with WSHFT for a friend or relative needing treatment (2013 staff survey) For 2013/14, the Trust s staff engagement score was above the average of 3.74 at The key themes we will focus on with our staff are: Facilitating and enabling them to contribute towards improvements at work Ensuring job roles and responsibilities that are stimulating, rewarding and motivating WSHFT-74% 80th centile-77% Creating an organisational culture where staff satisfaction is high Maintaining working environments where effective teamwork is in place and good working relationships exist at all levels We know from the findings of the National staff surveyand also from the Medical Engagement Scale that we need to pay particular attention to our medical anddental and facilities and estates staff. The outcome of the monthly Family and Friends tests for staff will be used to measure success of initiatives so that early interventions can take place. Q12a Q12a Q12a Q12a Q12a Care of patients / service users in my organisation s top priority My organisation acts on concerns raised by patients / service users I would recommend my organisation as a place to work If a friend of relative needed treatment, I would be happy with the standard of care provided by this organisation Staff recommendation of the Trust as a place to wok or receive treatment (Q12a, 12c-d) Source: 2013 NHS Staff Survey Your Trust in 2013 Average (median) for acute Trusts Your Trust in Staff health and wellbeing It is recognised that caring about staff health and wellbeing is a fundamental component of staff engagement, with mental health and stress related absence as a major contributor to sickness absence in the NHS. We understand that for staff to deliver high-quality care, they must be healthy and emotionally resilient themselves and they must be supported to cope with the demands of their work. Our health and wellbeing strategy includes the development of annual improvement plans. During 2014/15 we have successfully implemented a number of programmes including: Strengthening our arrangements with our Occupational Health provider Increasing the number of hours available for staff from our counselling service Introducing a staff physiotherapy service Designing and implementing mindfulness and stress management training for staff and managers to improve emotional resilience Annual flu vaccination programme Delivering a range of wellbeing events for staff exercise tasters yoga, Pilates and Zumba, try-a-bike sessions, healthy eating and lifestyle roadshows, sing-along stress busters, massage

14 Improved patient and staff experience (continued) During 2015/16 we will be measuring our progress as part of our pledged commitment to the Public Health Responsibility Deal. We will also be piloting the NHS Employers Creating Mentally Healthy Workplaces programme and evaluating its impact and success through nationally designed measures. We will continue to support the management of sickness absence through professionally recognised best practice. This will include early identification and intervention by managers when there are changes in behaviour, return to work interviews for every episode of sickness absence and formal action when an absence trigger is reached. Our aim is reduce sickness absence from 3.9% (at ) to 3.3% by the end of March 2016 with a reduction in the proportions of staff off with a stress-related or musculo-skeletal condition. Key Quality Improvement Priorities for We will deliver further continuous improvement in patient and staff experience through a number of focused quality improvement programmes including: Improving patient experience including: Night time care - reducing noise and night and ward moves that take place at night, Mealtime support, Information and communication with particular focus on the involvement of relatives/carers and discharge planning. A series of staff engagement roadshows and events will be rolled out across Divisions. The Surgery Division with support from NHS Elect, will pilot a number of initiatives during early 2015/16. Within the Facilities and Estates Division, a Steering Group, with representation from all levels of staff, is being established to oversee improvements in staff engagement. Initially focusing within the domestic and housekeeping teams, the group will oversee progress on a number of key projects including leadership development, health and wellbeing and recognition and reward. Successful initiatives will be rolled out across the Division. Workshops with medical staff have been established to identify and agree actions required to improve medical engagement, particularly amongst our experienced and longer serving consultant workforce. Learning from specialties where engagement is high will be built into the resulting projects. The programmes of work will focus on the findings of the medical engagement survey carried out in Extending staff health and wellbeing programmes throughout 2015/16. Outpatient experience In addition the Trust is implementing a significant improvement programme using the principles and approach of the Patient First programme to secure continuous improvements in the performance of our outpatient services, both in terms of efficiency and productivity and in patient experience.

15 Quality Culture Culture We believe that to improve the quality of care in a sustainable and affordable way we have to understand what our patients and our community want and need from us., We must harness the talents of all our staff to deliver it. We are building a culture in which patients and staff can be confident that their views matter and will be heard and where all staff have what they need to provide the best possible care for patients whether through direct patient care or in the supporting services. In order to create this change in culture we are reviewing and revising our Leadership strategy and the way in which we judge and develop leaders. It is increasingly recognised that developing a coaching and supportive approach, leads to a more engaged workforce. Workforce capability As part of the Trust s Patient First programme we are embarking on an ambitious training and development programme for staff, which will equip them with the skills to undertake quality improvement projects. The eighteen-month programme will involve a strategic partner to help train staff directly and to train the trainer so that at the end of the programme the Trust can be self-sustaining. In addition to this the Trust will be working closely with NHS Quest Foundation Trust partners to develop quality improvement programmes. Measurement for quality improvement Measurement is a key element of improving quality both in terms of indicating that levels are improving, but also as a driver for improvement itself. Measuring quality, however, is not as straightforward as measuring something immediately quantifiable such as finance. This strategy attempts to set out aspirational levels of achievement. In some cases these will be measures of the reliability of our processes (such the percentage of patients receiving all relevant elements of a care bundle) and in others the measures relate to patient outcomes (such as our mortality levels or the proportion of patients indicating they would recommend our services). To avoid clinicians having to spend a lot of time collecting data separately, wherever possible existing data sources will be used such as Patient Administration System (PAS) data, NHS Patient Safety Thermometer data, data provided to national audits but in some cases it may be necessary to establish new streams of data where the relevant items to establish a key measurement is not currently available. It will also be necessary to review all the measures carefully and sensibly to ensure that the information is meaningful and not just a set of targets. In order for the aspirations set out in this strategy to be realised it is necessary to ensure the availability of accurate, timely and well presented data. As well as data at hospital and Trust level, this also includes data at ward, specialty and in some cases individual clinician level to ensure that teams know whether they are improving or not. In addition to presenting credible and timely data back to clinical teams, over the life-time of the Quality Strategy there will also be a commitment to identify new ways of sharing this information with patients and carers to ensure transparency and establish greater confidence in the quality of local healthcare services. Collaboration The Trust collaborates with others to accelerate improvements in the quality of care we provide. These collaborations support the delivery of our quality improvement priorities. We are an active member of the Kent, Surrey Sussex Academic Health Science Network (KSS AHSN). We work collaboratively on programmes of work to enhance the quality of care through the implementation of evidence based care pathways. The Trust is a member of NHS Quest. NHS Quest is the first member-convened network for Foundation Trusts who wish to focus relentlessly on improving quality and safety. NHS QUEST members work together, share challenges and design innovative solutions to provide the best care possible for patients. Work is currently focused on managing deteriorating patients with objectives to reduce cardiac arrest and reduce sepsis. Other areas of work include falls prevention and medication safety. These are key quality improvement areas for the Trust. Conclusion To conclude, Western Sussex Hospitals NHS Foundation Trust is committed to delivering an ambitious programme of improvement in the quality of care we provide so that we provide best care every time. This document introduces our ambition in the key areas of mortality, safety, reliability together with patient and staff experience of care. We also set out areas of focus for our quality improvement programmes. Further detail around specific quality improvement programmes will be set out as an appendix to the Quality Strategy.

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